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Melanocytic Proliferations Associated With Lichen Sclerosus
J. Andrew Carlson, MD, FRCPC;
Xiao C. Mu, MD, PhD;
Andrzej Slominski, MD, PhD;
Kaare Weismann, MD, PhD;
A. Neil Crowson, MD;
John Malfetano, MD;
Victor G. Prieto, MD, PhD;
Martin C. Mihm, Jr, MD
Arch Dermatol. 2002;138:77-87.
Objectives To describe the clinicopathologic features of melanocytic proliferations
associated with lichen sclerosus (LS) and to compare these findings with those
in controls.
Design Cohort study.
Setting Academic and private practice dermatology and dermatopathology services.
Patients Cases of melanocytic proliferations associated with LS and consecutive
controls with persistent (recurrent) melanocytic nevi, persistent malignant
melanomas, and compound melanocytic nevi.
Main Outcome Measures Diagnostic criteria and disease recurrence.
Results Eleven patients, all female, with a mean age of 40 years (range, 8-83
years), presented with pigmented lesions clinically suspected to be malignant
melanoma or atypical melanocytic nevi affecting the vulva (7 patients), perineum
(3 patients), or chest (1 patient). Lichen sclerosus was first identified
in the biopsy specimen and subsequently confirmed clinically. In 10 cases,
a melanocytic nevus was superimposed on LS (overlying or entrapped by sclerosis),
whereas LS was found at the periphery of vulvar malignant melanoma. After
complete excision, no recurrences have been reported for the melanocytic nevi
in LS (mean follow-up, 29 months; range, 4-60 months). Compared with control
lesions, the LS melanocytic nevi most closely resembled persistent melanocytic
nevi and could be distinguished from persistent malignant melanoma histologically.
Melanocytes, nevoid or malignant, proliferating contiguously with fibrotic
or sclerotic collagen, contained abundant melanin, diffusely expressed HMB-45,
and had a higher Ki-67 labeling index than ordinary melanocytic nevi. However,
persistent malignant melanoma exhibited mitotic figures, significantly higher
Ki-67 labeling index, and deep dermal HMB-45 expression compared with LS melanocytic
nevi and persistent melanocytic nevi.
Conclusions Melanocytic nevi occurring in LS have features in common with persistent
melanocytic nevi and can mimic malignant melanoma. An "activated" melanocytic
phenotype is seen in LS melanocytic nevi, implicating a stromal-induced change.
From the Divisions of Dermatology and Dermatopathology (Dr Carlson),
Department of Pathology, Albany Medical College, Albany, NY (Drs Carlson,
Mu, and Mihm); Department of Pathology, University of Tennessee, Memphis (Dr
Slominski); Department of Dermato-Venerology, Bispebjerg Hospital, Copenhagen,
Denmark (Dr Weismann); Regional Medical Laboratories, Tulsa, Okla (Dr Crowson);
Associates in Gynecologic Care, Albany (Dr Malfetano); M. D. Anderson Cancer
Center, Houston, Tex (Dr Prieto); and Department of Pathology, Massachusetts
General Hospital, Boston (Dr Mihm).
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